CEDI Enrollment

Enrolling with CEDI is easy!

Completing Forms

CEDI enrollment forms must be completed and submitted on-line. Once your information is entered into the form, click the “Submit” button at the bottom of the screen. This will generate a printable version of the form for you to print, sign, date, and fax to the number located on the printed form. Do not print the screen before you click on “Submit”.

We have provided check lists for new providers to help make the process easier.

CEDI Enrollment Check List for New Providers Internal PDF file (370 KB) 
Information about the Transaction Options for CEDI Internal PDF file (286 KB)

Submitted CEDI enrollment forms will be issued Request Identification (RID) numbers which will appear on the printed copy of the form. The RID is used to track the submitted form. Forms that are printed before clicking the “Submit” button or have missing/invalid information will not be assigned an RID number. Verify your form(s) has an RID number before faxing.

IMPORTANT: Forms that are not printed after clicking on “Submit” and/or are not signed, dated, and faxed to CEDI will not be processed.

To help you avoid getting your forms returned, check out our guide on How to Avoid Common Errors When Completing Enrollment Forms Internal PDF file (244 KB)

Checking Status of Submitted CEDI Forms

The On-line CEDI Enrollment Application Status Tool allows you to check the status of your CEDI enrollment form(s) instantly through an internet web portal. You will need the Request Identification (RID) number or the NPI, PTAN, and date of the on-line submission to obtain status information.

You can also use the CEDI Interactive Voice Response (IVR) System to check the status of submitted enrollment forms 24 hours after the on-line submission.

The CEDI Enrollment IVR Guide Internal PDF file is provided to assist in using the IVR.

To check status of your form(s) call 866-311-9184 Option 2 and follow the prompts. The system will request the RID number from the form in order to check status.

IMPORTANT: Before completing the Enrollment forms, please Check the Crosswalk.

link to the Enrollment Forms and Instructional Guides Page